ELLIS R JACKSON

MACON, GA
NPI1659362283
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: GA  RN066377)
Enumeration Date2005-11-02
Last Update Date2017-04-12
Business Address
Mr. ELLIS R JACKSON CRNA
610 3RD ST
MACON, GA 31201-3294
Phone number: 229-344-6080
Mailing Address
Mr. ELLIS R JACKSON CRNA
427 FUSSELL RD
LEESBURG, GA 31763-5210
Phone number: 229-344-6080
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